- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.49 / $7.36 / $9.44
| Facility | | $6.49 | $7.36 | $9.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.28 / $9.44 / $9.44
| Professional | | $6.28 | $9.44 | $9.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.82 / $16.89 / $19.76
| Professional | | $12.82 | $16.89 | $19.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.87 / $9.44 / $11.81
| Professional | | $7.87 | $9.44 | $11.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $9.44 / $15.29
| Professional | | $3.31 | $9.44 | $15.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.81 / $14.31 / $19.82
| Professional | | $8.81 | $14.31 | $19.82 |